Combined Liver-Kidney Transplantation in Pediatric Patients From Colombia: A Case Series

Pediatric combined liver-kidney transplantation is uncommon, and evidence from Latin America is scarce.

We report a single-center case series of four pediatric recipients who underwent combined liver-kidney transplantation at a tertiary Latin-American center. We summarize primary indications, perioperative course, early complications, and graft function at follow-up.

Underlying diseases were primary hyperoxaluria type I (n = 1), nephronophthisis type 3 (n = 2), and hepatorenal fibropolycystic disease/autosomal recessive polycystic kidney disease (n = 1). Early complications included bacterial and viral infections, bleeding, and acute tubular necrosis. Three biopsy-proven acute rejection episodes occurred (one moderate-severe hepatic and two renal, including one late T-cell-mediated episode); all responded to treatment. At last follow-up, all four patients were alive with functioning liver and kidney grafts. In three cases with long-term follow-up, the estimated glomerular filtration rate was 72, 64, and 48 mL/min/1.73 m² with normal liver profiles; in one case with shorter institutional follow-up, the estimated glomerular filtration rate was 74 mL/min/1.73 m² with a transient liver profile abnormality.

This first pediatric series from Latin America suggests that combined liver-kidney transplantation is feasible and can achieve favorable long-term patient and graft survival when candidates are appropriately selected and infectious and rejection complications are managed in a protocolized manner.